But that doesn’t mean oral sex is risk-free. In fact, it’s one of the most common ways to spread sexually transmitted diseases, like chlamydia, gonorrhea, herpes, and human papillomavirus (HPV), according to the Centers for Disease Control and Prevention (CDC).

And depending on the strain you’re infected with, HPV can raise your risk of cancer—specifically of your oropharynx, or the middle part of your throat.

In fact, the number of people diagnosed with HPV-linked throat cancer is growing: Researchers found the presence of HPV in 21 percent of patients with oropharyngeal cancer before 1990. After 2000, 65 percent of sampled patients showed HPV, according to a meta-analysis published in Chemical Research in Toxicology.

“We’re just seeing the tip of the iceberg of this problem, and it’s really a public health crisis,” explains Ted Teknos, M.D., chairman for the Department of Otolaryngology–Head and Neck Surgery at Ohio State University’s Wexner Medical Center. He says that cases of HPV-related throat cancers have risen 300 percent from the 1980s to the 2000s.

“We’re just seeing the effects now, but it’s going to be much more common in the coming years and decades,” he adds.

Here’s everything you need to know about how oral sex can raise your risk for throat cancer—and exactly what you can do to protect yourself from it.

What Is Throat Cancer?

Throat cancer, officially known as oropharyngeal cancer, is more than twice as common in men than women, according to the American Cancer Society. It specifically affects your tonsils and the base, or the very back, of your tongue, says Dr. Teknos.

Throat cancer is different from oral cancer, which occurs in your lips, gums, tongue, linings of your cheek, or the roof or floor of your mouth. Throat cancer and oral cancer share some common causes—think smoking or chewing tobacco—but HPV is not one of them. Certain HPV strains are linked to throat cancer, not to oral cancer, he explains.

How Is Oral Sex Linked to Throat Cancer?

HPV is a shockingly common STD. Between 2013 and 2014, 45 percent of men aged 18 to 59 carried some form of HPV, according to the most recent CDC data. It's so common that if you’re sexually active, you'll probably contract it at some point in your life.

But that definitely doesn’t mean everyone who does will go on to develop the cancer. That’s because in the vast majority of the cases, your body will fight it off, clearing it from your system within 1 to 2 years.

Research shows that nearly 7 percent of Americans have oral HPV, but only 1 percent carries that cancer-causing type, according to the CDC.

If you’re unlucky enough to harbor a cancer-causing strain, proteins that are coded by the virus can attack your cells and cause them to grow out of control. At the same time, it messes with cell suicide—a scary-sounding process that’s actually completely normal, and stops cells from multiplying unchecked if there’s a problem there, explains Dr. Teknos. As a result, cancerous cells can begin to increase rapidly, causing the formation of the HPV-positive tumor.

Why Is HPV-Related Throat Cancer Increasing?

It wasn’t until recently that doctors and researchers made the link between HPV and throat cancer. Decades ago, the vast majority of throat cancers were caused by smoking—and the cancers were notoriously difficult to treat.

But from the early ‘80s to ‘90s, hospitals started seeing patients who had never smoked developing cancer in their tonsils, and their cancers were a lot easier to cure than the smokers’ cancer were.

“That’s when people knew something was different,” says Dr. Teknos.

Zeroing in on the sexual revolution of the 60s, they landed on HPV as the likely culprit. The STD can be passed by giving and receiving oral sex, and even by open mouth kissing alone. If your throat is infected with it, and you go down on your partner, you can transmit it to him or her, and vice versa.

Once it’s in your throat, it can lay dormant for decades—that’s why doctors are just now seeing an uptick in oral sex-related cancer diagnoses.

What Are Throat Cancer Symptoms?

Scary thing is, HPV-linked throat cancer is virtually symptomless at its early stages.

The telltale sign, which usually appears only when it's progressed to a more advanced stage? A painless lump in your neck. “It’s usually right where you get swollen glands from tonsillitis, the upper part of the neck right next to your voice box region,” explains Dr. Teknos.

Most guys will feel it while they’re shaving and mistake it for an infection—and if you rock a beard, you might not even notice it at all.

Other symptoms include trouble swallowing, subtle changes to your voice, and a mild sore throat that can persist and became more painful over time, but these are typically more pronounced in people with smoking-related throat cancer.

How Can Your Protect Yourself From HPV-Related Throat Cancer?

Most people catch HPV during their sexually robust college years, explains Dr. Teknos. In fact, about 10 percent of students on campuses have cancer-causing HPV in their mouths at any given time, he says.

Again, that doesn’t mean all those people will go on to get the cancer: In most cases, your body will clear the infection within two years (During that time, though, you’d still be able to pass it on to your partners).

The best way to dodge it is to play the preventive game. Get the HPV vaccine to protect yourself from the cancer-causing strains. If you’re 26 or younger, insurance will cover the vaccine. If you didn’t get it when you were a kid, you can still get the vaccine as an adult if you meet certain criteria, per the CDC’s recommendations. (Here’s exactly how you can prevent HPV.)

“There’s only about 1 percent of cancers that have been identified due to strains that may or may not be included in the vaccine, so it’s 99 percent preventable with vaccination—but the key is, you need to vaccinate yourself before you’re exposed,” says Dr. Teknos.

If you’re well over the vaccine age limit and don’t meet the other criteria, you can help keep yourself safe by limiting your number of sexual partners. Research shows your risk skyrockets once you’re sexually involved with six or more people, explains Dr. Teknos. Utilizing condoms and dental dams correctly can also lower your risk. (We love these Lelo Hex condoms from the Men’s Health store, since they’re ultra thin and pre-lubricated.)

Sex Ed: Condoms:

There’s not much you can do to minimize your risk once you’ve been diagnosed with HPV. Think of it this way: People who smoke a lot and drink heavily are at a 40 times higher risk of developing throat cancer malignancies than people who don’t.

That risk is 55 times higher for someone with HPV, says Dr. Teknos.

But if you do get the cancer from your HPV infection, there’s more than a 90 percent chance that you’ll successfully be cured of it, he says. Like with all cancers, earlier detection can improve your changes of survival, so if you notice any of the symptoms listed above—especially if you’ve been diagnosed with HPV—loop in your doctor as soon as possible.

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